title: Time-dependent decrement of dermal gadolinium deposits and significant improvement of skin symptoms in a patient with nephrogenic systemic fibrosis after temporary renal failure.
abstract: BACKGROUND
  Nephrogenic systemic fibrosis (NSF) represents a rare fibrosing disorder occurring after administration of gadolinium-containing contrast agents during renal insufficiency. In order to prove the effect of gadolinium elimination on clinical signs, we identified and quantified gadolinium in skin biopsies of a 62-year-old patient with NSF with regard to improving skin lesions after recovery of renal function.
  
  
  METHODS
  Gadolinium deposits were visualized and identified in NSF skin biopsies by light microscopy and transmission electron microscopy (EM) and by scanning EM. Inductively coupled plasma-mass spectrometry (ICPMS) was used for quantifying gadolinium concentration.
  
  
  RESULTS
  Transmission EM studies revealed electron-dense material in connective matrix around blood vessels and inside lysosomes of histiocytes and fibroblasts. A remarkable reduction of gadolinium deposits was observed in transmission EM and scanning EM and confirmed by ICPMS in follow-up biopsies. After spontaneous recovery of renal function, his skin induration improved notably over the next 2 years.
  
  
  CONCLUSIONS
  The reduction of clinical and histomorphological signs of NSF correlated with decreasing gadolinium concentration in skin biopsies within 3 years. Our study suggests a possible pathogenetic mechanism of NSF including a chance for recovery after elimination of gadolinium and reduced histamine liberation by mast cells.
authors.affiliation: Department of Dermatology and Venereology, University of Rostock, Rostock, Germany.
authors.forename: Susanne G
authors.initials: SG
authors.lastname: Schäd
authors.forename: Peter
authors.initials: P
authors.lastname: Heitland
authors.forename: W Nikolaus
authors.initials: WN
authors.lastname: Kühn-Velten
authors.forename: Gerd E
authors.initials: GE
authors.lastname: Gross
authors.forename: Ludwig
authors.initials: L
authors.lastname: Jonas
mesh_terms: D003287:Contrast Media / Q000009:adverse effects* / Q000032:analysis; D005682:Gadolinium / Q000009:adverse effects* / Q000032:analysis; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D054989:Nephrogenic Fibrosing Dermopathy / Q000139:chemically induced* / Q000473:pathology*; D051437:Renal Insufficiency / Q000175:diagnosis; D012867:Skin / Q000737:chemistry* / Q000473:pathology; D013995:Time
chemical_list: D003287:Contrast Media; D005682:Gadolinium
keywords: electron microscopy; gadolinium; inductively coupled plasma-mass spectrometry; nephrogenic systemic fibrosis; renal failure